Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Code Type Title Short Definition Definition
109 R Rejected,
Duplicate
PBP Number
110 R Rejected; No
Part A and
No EGHP
Enrollment
Waiver
114 R Drug
Coverage
Change
Rejected; not
AEP or OEPI
ALREADY
ENROLL
NO PART
A/EGHP
RX NOT
AEP/OEPI
An enrollment transaction (Transaction Type 61) was rejected because the member is already
enrolled in the PBP # on the transaction.
The effective date of the requested enrollment is reported in TRR data file field 18.
Plan Action: If the submitted PBP was correct, no Plan action is required. If another PBP was
intended, correct the PBP # and resubmit if appropriate.
A PBP enrollment change transaction (Transaction Type 61) was rejected because the beneficiary
lacks Part A and there was no EGHP Part B-only waiver in place.
Plans can offer a PBP for EGHP members only, and, if the Plan chooses, it can define such PBPs for
individuals who do not have Part A.
Plan Action: Review CMS enrollment guidance in Chapter 2 of the MMCMor the PDP Guidance
on Eligibility, Enrollment and Disenrollment and notify the beneficiary.
An enrollment change transaction (Transaction Type 61) was rejected because the beneficiary is not
allowed to add or drop drug coverage using an O (OEP) or N (OEPNEW) election types.
Using O or N, a beneficiary who is in a Plan that includes drug coverage may only move to another
Plan with drug coverage. Likewise, if in a Plan without drug coverage, the beneficiary may not
enroll in a Plan with drug coverage or a PDP.
Occasionally, if a beneficiary is moving from a Plan with drug coverage to a combination of standalone
MA and PDP plans, the enrollment transaction in the MA-only plan may be processed prior
to the enrollment transaction in the PDP plan. Since this appears to CMS as if the beneficiary is
trying to drop drug coverage, the enrollment into the MA only Plan will be rejected with TRC 114.
Once the enrollment in the PDP is processed, the enrollment in the MA-only may be resubmitted.
Plan Action: Review CMS enrollment guidance on the O and N election type limitations in
Chapter 2 of the MMCMor the PDP Guidance on Eligibility, Enrollment and Disenrollment. Take
the appropriate actions as per CMS enrollment guidance.
Note: If TRC 114 is received by an MA-only Plan when using the OEP or OEPNEW, the Plan
should determine if the beneficiary is enrolled in an accompanying PDP. Once that enrollment is
complete, the MA-Only Plan may resubmit their enrollment transaction.
December 28, 2012 I-27 Transaction Reply Codes (TRCs)